Context: The worldwide incidence of onychomycosis is increasing and it continues to spread and persist. Knowledge of the epidemiological and mycological characteristics is an important tool for control of this infection. Aims: This study seeks to improve knowledge of onychomycosis epidemiology and mycological features. Settings and Design: Over a period of five years (Jan 2000 - Dec 2005) samples from 400 patients with clinical suspected fungal nail infections, who attended dermatology out patient department at a tertiary care hospital, were obtained. Materials and Methods: 400 nail specimens of suspected onychomycosis were evaluated clinically, KOH examination and fungal culture was done. Results: Onychomycosis was present in 218 (54.5%) by culture and /or direct examination. Fingernails and toenails were infected in 65% and 32% respectively and remaining 3% had both. Conclusions: This study demonstrated that dermatophytes were main agents causing onychomycosis in our region, as well as the importance of performing direct examination and culture in diagnosis of onychomycosis.

Wuchereria bancrofti presented in subcutaneous nodule is a very rare presentation. Wuchereria bancrofti first reported by Bancrofti in Brisbane in 1876 and the name filaria Bancrofti was given in 1877 and the generic name was given in 1878. A 15-year-old male patient's known case of pulmonary Koch's with incidentally detected subcutaneous nodule on right arm pit, cytology from the nodule shows many sheathed microfilaria along with segment of an adult female worm. Wet mount peripheral blood smear shows nocturnal motile microfilaria. The Wuchereria bancrofti is known to be associated with pulmonary Koch's. Nocturnal motility and cytomorphological features differentiate Wuchereria bancrofti from Wuchereria loa loa . After giving diethyl carbamazine (DEC 6 mg/kg) for 21 days without disturbing anti Koch's treatment schedule and microfilaria disappeared from peripheral blood.

Larvae of Chrysomya bezziana are the commonest cause of wound myiasis in some parts of the world. This obligatory parasite is important in humans and in commercial livestock. Kumarasinghe et al have reported that essential oil of betel leaf (EOBL) is larvicidal to C. megacephala but there are no publications on its effect on C. bezziana . This study was done to evaluate the efficacy of essential oil of betel leaf ( Piper betle ) against the larvae of C. bezziana in vitro . EOBL was prepared at the Industrial Technology Institute Colombo, Sri Lanka, according to a standard protocol. The experiment on larvae was carried out at the Research Institute for Veterinary Sciences in Bogor, Indonesia. EOBL concentrations of 2%, 3% and 4% were prepared with Tween 80. Two ml of 4%, 3% and 2% EOBL in 1% Tween 80 (v/v/aq) were poured into separate Petri dishes. Ten 1st and 2nd instar larvae were placed in each Petri dish. Asuntol (Chaumaphos) 1% was used as positive control and distilled water with 1% tween 80 was the negative control. Larval mortality was assessed half-hourly. The experiment was repeated five times and averages were compared. Sustained immobility of the larvae, after exposure to the relevant substances was considered as death. The efficacy of EOBL depended on, the stages of C. bezziana larvae and the concentration. With 4% EOBL, all first instar larvae were killed within two hours and the second instar larvae were killed by four hours. The positive control showed no mortality until four hours but all larvae were weak, from the first 30 minutes. In the negative control, larvae were mobile and active. EOBL 3% killed all the first instar larvae by 150 minutes and 74% of the second instar at four hours. By 210 minutes, 2% preparation had killed 100% of the first instars. EOBL is an effective larvicidal for C. bezziana first and second instar larvae in vitro . This natural product has a great potential to be developed as a novel larvicide against this parasite.

Sweat gland neoplasms are rare with approximately 200 cases of eccrine sweat gland and less than 50 cases of apocrine gland carcinoma being reported in the worldwide literature. More than half of the reported cases with apocrine adenocarcinoma had lymph node metastases at the time of diagnosis. We report a case of a 56-year-old man, presented with a left axillary slow-growing seven year old painless nodule. Histopathological examination revealed an invasive apocrine adenocarcinoma with lymph node metastases. The patient successfully treated with total excision and radiotherapy. Apocrine adenocarcinoma is a rare malignancy with high metastatic potential that occurs mostly in the axilla. Physicians should be aware of this entity while differentiating cutaneous tumor located on the axillary region.

Background: The aim of this study was to investigate the role of FcgRIIB gene in susceptibility to systemic lupus erythematosus (SLE) using family-based association study and to examine possible interaction between the Ile225Thr (rs1050501, exon 5) polymorphism of Fcg receptor IIB gene and hypersensitivity. Objectives: A total of 119 patients with SLE from 95 nuclear families, aged 14 to 78 years, according to the American College of Rheumatology (ACR) 1997 criteria were recruited. In addition, 316 family members of these patients were also genotyped. Seventy patients and their 70 normal siblings from 95 nuclear families were selected by the case-combined-control design. Materials and Methods: A family-based association study was used to explore the relationship between gene polymorphism and SLE. We studied a single-nucleotide polymorphisms (SNPs) encoding non-synonymous substitution in the FcgRIIB gene with respect to genetic susceptibility to SLE, the FcgRIIB gene were genotyped by restriction fragment length polymorphism (RFLP) method. The interaction of gene-environment was assessed by conditional logistic regression model.
Results: Among 119 SLE patients, The frequencies of FcgRIIB Ile225Ile, Ile225Thr and Thr 225 Thr genotypes were 8.1%, 61.3% and 30.6%. Univariate (single-marker) family-based association tests (FBATs) demonstrated that variant allele at SNP rs1050501, in exon 5 of FcgRIIB gene was significantly associated with genetic susceptibility to SLE in additive model (exon 5, Z=3.707, P =0.00020). Transmission/disequilibrium test (TDT) and sibship disequilibuium test (SDT) analysis showed an excess of the allele of 225Thr ( Ile225Thr loci) from heterozygous parents to affected offspring (c 2=7.14, P =0.0105); Moreover, conditional logistic regression results showed that there was statistically significant multiplicative interaction of FcgRa!B gene and the Hypersensitiveness [c 2=5.013, P =0.024; OR=2.444, CI (1.126-5.309)]. Conclusions: Our findings provide strong evidence suggesting a Ile225Thr polymorphism might be the susceptibility factor of SLE; a possible gene-environment interaction between hypersensitiveness and Ile225Thr mutation in Chinese population.

Sebaceous horn or cutaneous horn of the nose is a rare clinical entity. A case of a giant sebaceous horn of the nose presenting in an elderly male, which was successfully excised and reconstructed is reported.

Mycosis fungoides (MF) is the most common group of cutaneous T-cell lymphomas. It is a rare non-Hodgkin's lymphoma of mature, skin-homing, clonal, malignant T lymphocytes, usually observed in mid to late adulthood, that initially presents in the skin as patches, plaques, tumors, or generalized erythema (erythroderma) and can involve the lymph nodes and peripheral blood. Much progress has been made in recent years in understanding the origin of the malignant T cell in MF and the patho-physiology and immunology of the disease. This recent work has made a great impact on diagnosis, prognostication, and treatment. In this review, we survey the MF literature of the last decade and highlight the major trends.

Background: Pitted keratolysis is a common dermatological condition. However, very few studies are available on the clinical characteristics and epidemiological features of this disorder from India and abroad. Materials and Methods: Fifty patients from rural area of Kolar at Sri R.L.J.H. and S.N.R. Hospital, presenting with clinically distinctive lesions of pitted keratolysis were included in the study. Cases were interviewed with particular emphasis on triggering factors and findings were recorded. Investigations like Gram's stain, culture studies, Wood's ultraviolet light examination, histopathology etc, was done in selected cases to ascertain the clinical diagnosis. Results: Age of the patients varied from 20 to 40 years in 52% with male preponderance in 82% of cases. Duration of the disease varied from 15 days to five years, most of the patients were bare-footed farmers (62% of cases). Hyperhidrosis and pruritus were most frequently observed symptoms in 70% and 60% of patients. Most of the patients presented with the characteristic pits which varied from 1 to 50 in number in 56 % of cases, located predominantly on the pressure bearing areas in 92% of cases and depth of the pits varied from 1 to 2 mm in 60% of cases. Associated skin conditions recorded in present study were fissuring of soles in 38%, psoriasis 10%, dermatophyte infections in 6%, planter warts 6% and Corynebacterial triad and corn in 2% of patients each. Discussion: Affection of bare-footed individuals, male preponderance, presence of hyperhidrosis and occurrence of lesions over pressure bearing areas of soles, observed in the present study were consistent with earlier studies on the subject. However, pruritus as commonest presenting symptom reported by 60% patients in the present study, has not been documented in the previous studies. Conclusion: Pitted keratolysis is fairly common in bare footed male farmers of rural India. The condition is predominantly seen over the pressure bearing areas of sole and hyperhidrosis is common precipitating factor. Pruritus, a common presenting symptom observed in this study has not been reported earlier.

Prolidase deficiency is a rare inborn disorder of collagen metabolism characterized by chronic recurrent skin ulceration. A seven-year-old girl and her younger sibling with clinical features and laboratory criteria fulfilling the diagnosis of prolidase deficiency are presented in view of rarity of the condition.

Background: Fungal infection of the nails is a common, difficult to treat problem, prevalent worldwide. A discrepancy in the microscopic examination and culture findings can create problems in the diagnosis of this common infection.
Aim: This study was designed to evaluate a new method for accurate diagnosis of onychomycosis. Materials and Methods: Nail samples from 25 patients of suspected onychomycosis were taken. A portion of the samples was treated with 2% trypsin before culturing and the rest was processed by the standard mycological technique. Results: A higher number of culture positive samples were obtained by the trypsin treatment method as compared to the standard technique. Conclusion: Trypsin treatment prior to culture increases the isolation of fungi from nail samples.

Perianal eczema is a kind of inflammatory dermatosis on the perianal skin and mucosa. The aim of the study was to evaluate the clinical efficacy of the combined therapy of medicine and operation for the perianal eczema caused by the anal diseases such as hemorrhoids, fissures and fistulas. One hundred and sixty patients with perianal eczema were involved in this study. They were randomly divided into four groups and treated by different therapies for four weeks respectively. Group A (40 patients) was only treated with medicine, Group B (40 patients) only with operation, Group C (40 patients) firstly with medicine and then with operation and Group D (40 patients) firstly with operation and then with medicine. The efficacy was determined as reduction of lesion size relative to initial size. The cure rate was 22.50%, 32.50%, 57.50% and 45.00% in Group A, B, C and D, respectively. The effective rate was 40.00%, 52.50%, 85.00% and 75.00%, respectively. The efficacy was significantly different (H=20.8689, g = 3, P value =0.0001). The results of group comparison showed that there were significant difference between Group C and Group A, Group C and Group B, Group D and Group A (all P values, < 0.05). It was concluded that the combined therapy of medicine and operation is optimal choice for the perianal eczema caused by the anal diseases such as hemorrhoids, fissures, and fistula. It highly improves the cure rate and efficacy rate.

Patients with lupus erythematous may develop an acute eruption clinically similar to toxic epidermal necrolysis or erythema multiforme. The presence of erythema multiforme-like lesions and characteristic pattern of immunological abnormalities including antinuclear antibody (speckled pattern), anti-Ro antibody or anti-La antibody and positive rheumatoid factor in lupus patients has been termed as Rowell's syndrome. Although diagnostic criteria of this syndrome have been reviewed recently, definite mechanisms of pathogenesis is still unknown. Here we reported a 29-year-old female patient who had systemic lupus erythematosus developed erythema multiforme-like lesions.

Background: Physical differences among human populations may lead to variable prevalence of skin disorders in different ethnicities. Skin infections are one of the important curable and largely preventable categories of skin disorders in the communities. Aim: The purpose of the study was to see the patterns of skin infections in black Africans of Sierra Leone and to compare with other ethnic populations. Materials and Methods: Local blacks of all age groups presenting in Dermatology out patient department of Pak Field Hospital (established as a part of UN peacekeeping mission in Sierra Leone) were included (from Nov 2004 to Oct 2005). Relevant clinical history and physical examination was done. Laboratory investigations were carried out when indicated. Skin diseases were broadly classified into two major categories i.e., infective and noninfective. Among infective, sexually transmitted infections were again separated. Nonblack settlers in the area and UN troops were not included in the study. Data was recorded and analyzed by Microsoft Excel program. Results: 3011 patients belonging to different local tribes having a variety of skin disorders were seen. Patients were of all ages and both sexes ranging from one month to 73 years of age. The Infective skin disorders were seen in 61.7% patients and most prevalent were superficial fungal infections (41.2%) followed by, sexually transmitted infections (9.9%) and parasitic infections (6.5%). Bacterial and viral infections were rare and so was the scabies. More than 90% parasitic infections were onchocerciasis with full spectrum of cutaneous manifestations. Conclusion: Pattern of skin infections in blacks varies considerably from other ethnic races. Environmental factors, geographical location and free existence of vector for onchocerciasis in West African region, possibly have a significant influence in this variable prevalence.